July 10, 2014

National Update

CMS issues 2015 Medicare physician payment proposed rule

Major changes in the Medicare physician payment policy were proposed by the Centers for Medicare & Medicaid Services (CMS) with the release of its annual notice of proposed rulemaking July 3. Public comments on the proposed rule are due Sept. 2. The final rule is expected to be issued by Nov. 1, and implementation is scheduled for Jan. 1.

Some of the key issues addressed in the CMS proposal include:

Unbundling of the 10- and 90-day global surgical services

Changes to the process and timelines for revising relative values

New payment policies and rates for chronic care management services

Changes to the Sunshine Act regulations

Modifications to the Medicare performance-based payment programs, such as the Physician Quality Reporting System and Value-Based Modifier

These proposals and others are outlined in several fact sheets available on the CMS website. The AMA will submit extensive comments on the proposed regulation.

Following concerns expressed by the AMA and other medical societies, the Centers for Medicare & Medicaid Services (CMS) has released a proposed rule for the 2015 Medicare home health prospective payment system that would change the face-to-face encounter rules by eliminating the narrative requirement.

As part of certification of eligibility, physicians still would be required to certify that a face-to-face encounter occurred and document the date of the encounter. Physicians and other stakeholders have expressed concern that auditors have been overly aggressive in reviewing the face-to-face narrative requirement. The AMA will comment on the proposed rule and continue to engage CMS on this issue.

HIPAA audits to resume shortly; physicians need to be compliant

For physicians who haven't conducted a privacy and security risk assessment recently, now's the time to do so. The U.S. Department of Health and Human Services Office for Civil Rights (OCR) plans to implement random Health Insurance Portability and Accountability Act (HIPAA) audits to monitor compliance, beginning as soon as later this summer.

Building on a HIPAA auditing program piloted in 2012, the agency expects to launch random HIPAA audits focused on ferretting out major threats to patient health information confidentiality and network security.

Failure to comply with HIPAA's privacy, security and breach notification requirements likely will result in financial penalties that could be significant. Recent OCR data shows that 60 percent of security breaches come from theft and loss of technology containing protected health information. However, issues related to hospital and practice staff using their own mobile devices and unsecure Wi-Fi networks are on the rise.

The AMA offers a number of free resources to help physicians' practices comply with the HIPAA requirements. Read more at AMA Wire™.

Issue Spotlight

Physicians only have weeks to protect against inaccurate reporting

Financial interactions between physicians and manufacturers of drugs and medical devices—including everything from research and ownership interests to reprinted journal articles and meals—soon will be made public under the Physician Payments Sunshine Act (also known as the Open Payments Program). Doctors need to act quickly to make sure they're protected from inaccurate reporting.

The AMA successfully convinced the Centers for Medicare & Medicaid Services (CMS) that physicians should be able to review and dispute the financial data drug companies have reported about them prior to publication, but the agency has left very little time for physicians to do so.

Make sure the physicians who belong to your medical association know they have a way to protect themselves and understand the steps to take.

Time is of the essence. There are three steps physicians must take in order to review and dispute the data reported about them:

Step 1: Complete CMS' e-verification process, which opened June 1 and must be finished before physicians can take the next step.

Step 2: Register with CMS' Open Payments system, which should be available in a matter of days.

Step 3: Review and dispute their data within 45 days.

Disputes that are filed before a yet-to-be-announced August cut-off date will be flagged as such in the initial public release Sept. 30. Physicians will have until Dec. 31 to retrospectively file disputes about their data.

Physicians can access the practical information they need to navigate the Sunshine Act data release in a free online toolkit from the AMA.

Download a package of ready-made communications materials, including sample articles, an infographic and social media postings. Additional materials will be added as steps 2 and 3 become available.

Possible changes to the continuing medical education (CME) exemption: In the proposed Medicare Physician Fee Schedule for 2015, CMS has proposed revoking the Sunshine Act exemption of financial transfers made to organizations that offer independent CME accredited by the Accreditation Council for Continuing Medical Education or when credit is granted by the AMA, American Academy of Family Physicians, American Osteopathic Association or American Dental Association.

The agency instead is proposing to exempt third-party financial transfers for CME only when an industry donor is unaware of the recipients or beneficiaries before and after the funds are transferred. This raises concerns because the industry potentially could learn the identities of speakers and participants through brochures, programs and other publications related to a CME event after the funds have been transferred.

The AMA is concerned that the proposal will have a chilling impact on accredited CME. The proposed fee schedule rule also includes two other options that address CMS' concerns about the current structure of the CME exemption. The AMA is evaluating these options and will be in communication with the Federation as it prepares comments.

State Update

California allots $7 million for primary care residency slots

Unprecedented grassroots advocacy by the physician and medical student community, including the AMA Medical Student Section and the California Medical Association, has led the California legislature to approve and the governor to sign a state budget that includes $7 million for new primary care residency slots.

This critical funding will help California meet an increased demand for medical services. An AMA letter to the state legislature strongly encouraged this funding, stressing that support for graduate medical education (GME) is necessary to preserve a health care system that provides high-quality preventive, acute and chronic care that meets the needs of an aging and increasingly diverse population.

Of this new funding, $3 million will be applied to expand a state residency funding program to include family medicine, internal medicine, obstetrics-gynecology and pediatric primary care specialties. The additional $4 million will provide one-time funding for residency programs that wish to expand and train more residents.

The budget act requires that priority be given to programs with graduates of California-based medical schools, reflecting the overwhelming data that physicians are very likely to practice in the state in which they obtain their medical degree and complete training.

The AMA will continue to advocate for increased GME funding to enhance the ability of medical schools and teaching hospitals to train physicians, while ensuring access to care for patients.

Two states enact legislation to address drug overdose

Efforts to increase awareness and expand access to the overdose reversal drug naloxone continue to increase across the country, with Delaware and Louisiana becoming two of the most recent states to enact new naloxone-related laws.

Delaware Senate Bill 219 includes provisions that increase education and training on the safe use of naloxone, and the bill also seeks to establish a community-based naloxone access program based on best practices. Louisiana House Bill 754 will provide increased access to naloxone for first responders. At least 14 states have enacted naloxone-related laws so far this year.

The AMA supported the legislation in both Delaware (AMA login required) and Louisiana (AMA login required).

AMA testifies in favor of prevention, treatment for substance abuse

Substance abuse is a disease that should be treated—not stigmatized, AMA Board of Trustees Member Mary Anne McCaffree, MD, told state lawmakers Thursday at the National Conference of Insurance Legislators (NCOIL) summer meeting in Boston.

Dr. McCaffree, a neonatal-perinatal specialist in Oklahoma City, expressed the AMA's support for additions to NCOIL's official "Recommended best practices" to combat prescription drug abuse and diversion. The organization continues to support a comprehensive approach to this public health crisis, rather than one-size-fits-all tactics.

In her comments, Dr. McCaffree called specific attention to three areas outlined in a recent letter to NCOIL (AMA login required):

Lawmakers should pay close attention to the privacy issues raised by increased use of prescription drug monitoring programs.

The AMA strongly supports evidence-based, public health practices to treat neonatal abstinence syndrome, including those published and adopted by medical organizations, such as the American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics and American Society of Addiction Medicine.

Judicial Update

An appeals court decision delivered June 27 defeated a move that would have brought government intrusion into the regular scope of medical practice.

In Kentucky Board of Chiropractic Examiners v. Barlow, an appeals court upheld the ability of physicians to provide expert review and testimony in keeping with their full scope of practice and training.

In its suit, the Kentucky Board of Chiropractic Examiners claimed that physicians could not provide expert review of medical records involving chiropractic services, citing a state statute that limits peer review to other chiropractors. The argument sought to conflate peer review, which assesses the actions or competence of a licensed practitioner, with the broader concept of expert opinions.

"Blurring the lines between expert review and peer review would be a disservice both to litigants and to health care professionals," the brief stated. "Each type of review serves different purposes and involves different processes, procedures and results."

Other News

Sign up for AMPAC's 2015 political education programs

AMPAC, the AMA's Political Action Committee, will host its annual Candidate Workshop Feb. 20-22 in Arlington, Virginia. The workshop is designed for AMA members and their spouses who are considering a run for public office and includes training on campaign strategy and media advertising, as well as hands-on sessions in public speaking and fundraising. In the 2012 elections, 13 graduates of the workshop were elected to federal and state offices, and an additional 17 candidates are running in the 2014 elections.

Also in Arlington, Virginia, AMPAC will conduct its annual Campaign School April 15-19 for AMA members who wish to get involved in the political process as advocates and volunteers for medicine-friendly candidates. The school is organized around a simulated congressional campaign, in which participants are put on mock campaign staff teams and attend daily lectures about campaign strategy, media advertising and political fundraising. Each team participates in nightly exercises, such as creating a campaign strategy, recording a radio commercial and writing a political fundraising letter.

For both programs, AMPAC covers all costs for AMA members, except transportation to the Washington, D.C., metro area. Space is limited: Register online today, or email Jim Wilson, AMPAC's political education programs manager, for more information. Interested physicians, residents and medical students who are members of the AMA, as well as their spouses and medical society staff, are welcome to apply.

News You Can Use

Following is suggested content to use in your association's communication vehicles beginning in July. This month's focus is on the Physician Payments Sunshine Act, for which physicians need to start preparing now. Additional ready-made communications materials will be added online as the Centers for Medicare & Medicaid Services makes steps 2 and 3 of the program available.

Please email Terri Marchiori of the AMA to let us know which materials you're placing, your distribution channels, the response from your members and any other metrics, such as audience reach.